Provider Demographics
NPI:1215004551
Name:THIER, STEPHANIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN
Last Name:THIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2802
Mailing Address - Country:US
Mailing Address - Phone:507-727-3937
Mailing Address - Fax:507-727-3939
Practice Address - Street 1:1607 MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2802
Practice Address - Country:US
Practice Address - Phone:507-727-3937
Practice Address - Fax:507-727-3939
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203300Medicaid
SD9203302Medicaid
SD9203302Medicaid